Screening for sleep apnea in the young hypertensive: evidence from a case-control study in Malaysia

Objective : Younger patients with sleep apnea have higher risks of cardiovascular mortality compared to their normal counterpart. Yet, it remains a continued struggle to find a suitable cost-effective means of screening for sleep apnea in the young population. We conducted a case-control study of the possible association between sleep apnea and hypertension in a younger population in Malaysia. Method : We analyzed data on sleep disordered breathing (based on a polysomnography study), body mass index (BMI), neck circumference, upper airway size, habitus and health history in 90 hypertensive and 90 non-hypertensive participants in a clinic-based setting. Independent t-test, chi-square, multivariate analysis and binary logistic regression models were used for case-control comparison. Results : The mean age of the participants was 28 years; 69.5 percent were men. The incidence and severity of sleep apnea were significantly higher in the hypertensive subjects than the control’s. Persons with sleep apnea (AHI 5 or more events/hour) had odds ratio 2.76 (95% confidence interval 1.57-4.86) and persons with severe sleep apnea (AHI 30 or more events/hour) had odds ratio 7.94 (95% confidence interval 4.21-15.33) of having hypertension than did persons without sleep apnea. Although adjustments for the compounding factors, particularly the BMI decreased the odds ratio to a large degree, subjects with severe sleep apnea were still 72% more likely to have hypertension than subjects without sleep apnea. Conclusion : Sleep apnea is associated with hypertension in the young adult in Malaysia. The association was more pronounced with the increasing severity of sleep apnea. Screening for sleep apnea should be considered in young adult with hypertension